Promoting Patient-Centered Counseling to Reduce Inappropriate Diagnostic Tests

Not Applicable

Completed

• Conditions: Osteoporosis; Primary Care; Headache; Low Back Pain; Magnetic Resonance Imaging; Unnecessary Procedures
• Interventions: Behavioral: Standardized Patient Instructor Intervention; Behavioral: Control

• Registration Number: NCT01808664
• Lead Sponsor: University of California, Davis

Brief Summary

In this study, the investigators will develop and evaluate a novel intervention using standardized patients (SPs) -- or actors playing the roles of patients -- to enhance physicians' patient-centered counseling skills regarding two frequently overused, potentially inappropriate services in primary care: magnetic resonance imaging (MRI) for acute low back pain and bone densitometry in women at low-risk for osteoporosis. The investigators will further evaluate whether intervention effects on physician patient-centeredness generalize to counseling regarding other costly, unnecessary diagnostic tests.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2012-11-20
• Study First Submitted QC: 2013-03-07
• Study First Posted: 2013-03-11
• Study Start: 2013-04
• Primary Completion: 2014-09
• Study Completion: 2014-12
• Status Verified: 2020-02
• Last Update Submitted: 2020-02-24
• Last Update Posted: 2020-02-26

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 61

Inclusion Criteria

• Resident physician in family medicine or internal medicine who deliver primary care at one of two hospital-based primary care clinics at the University of California, Davis Medical Center Sacramento

Exclusion Criteria

• Anticipated graduation in less than one year from enrollment.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Standardized Patient Instructor Intervention	Standardized Patient Instructor Intervention	Primary care physicians (PCPs) randomized to intervention will receive over a three month run-in period two visits by standardized patient instructors portraying: 1) a 48 year-old patient with low back pain for less than six-weeks and no "red flags" for immediate spinal imaging; and 2) a 50 year-old recently menopausal woman establishing care with concerns about osteoporosis risk.
Control	Control	In the latter half of visits with control PCPs, standardized patient instructors (SPIs) will share information regarding low back pain or bone health that are unrelated to diagnostic testing, but will not discuss patient-centered techniques or conduct training. The total duration of the control "information sharing" will be about one-third the SPI intervention to enhance patient-centeredness.

Primary Outcome Measures

Name	Time	Method
Number of inappropriate diagnostic tests ordered	9 months	Investigators will assess via blinded, standardized chart review whether study physicians ordered inappropriate diagnostic tests for unannounced standardized patients who request testing during three follow-up visits occurring 3 to 9 months post-randomization.

Secondary Outcome Measures

Name	Time	Method
Use of patient-centered counseling techniques	9 months	Physician use of patient-centered counseling techniques as assessed via masked recordings of three standardized patient visits
Actual diagnostic test ordering among real patients	9 months post-intervention	Among real patients seen by study physicians, we will assess diagnostic test ordering among actual adult patients during the post-intervention period. We will also assess comparable diagnostic test ordering during the pre-intervention period to enable adjustment for baseline test ordering.